Skeletal muscle protein reserve after bone marrow transplantation in children.

To evaluate the long-term profile of nutritional status in children undergoing BMT, we carried out a 1-year follow-up of 42 consecutive patients. The skeletal muscle protein reserve was assessed by ultrasonography, and by calculating the mid-arm muscle area from skinfold and arm circumference measurements. Ultrasonography proved to be superior to anthropometry. During the first month after BMT, the skeletal muscle protein reserve decreased by 11% (95% CI -20 to -4%), and only began to recover gradually several months after BMT. The serum transferrin concentration decreased significantly during the first post-transplant month, then slowly returned to normal by the end of the first post-transplant year. The 23 patients with allogeneic transplants and 19 with autologous transplants were fully comparable in nutritional respects. Despite total parenteral nutrition the total energy intake did not reach the weight-based target level. The patients in whom pretransplant protein energy reserves were severely reduced, were at increased risk of dying of relapse. We conclude that ultrasonography is a valuable method for assessing protein energy reserves in BMT patients. Pretransplant nutritional status has a considerable impact on post-transplant survival. We emphasize the importance of both pre- and post-transplant nutritional support.